<body class="main">
        <div class="fullscreen background main-bg" data-img-width="1600" data-img-height="1064">
            <div class="content-a">
                <div class="content-b">
                    <div class="content-c">
                        <h2 class="header-content">WELCOME TO THE FUTURE</h2>
                        <h5 class="sub-content">
                            PLEASE ACCOMPLISH THE FORM BELOW TO CONFIRM YOUR SLOT<br />
                            ENROLMENT DETAILS AND PROCEDURES WILL BE SENT TO YOUR<br />
                            REGISTERED EMAIL ADDRESS.
                        </h5>  
                        <form id="submit-app" method="post" action="<?php echo base_url(); ?>home/submit_application">
                        <div class="row">
                            <div class="col-lg-4 col-md-6 col-xs-12">
                                <input placeholder="SURNAME" type="text" class="form-input" name="surName" />
                                <p class="error" rel="surName"></p>
                            </div>
                            <div class="col-lg-4 col-md-6 col-xs-12">
                                <input placeholder="GIVEN NAME/S" type="text" class="form-input" name="givenName" />
                                <p class="error" rel="givenName"></p>
                            </div>
                            <div class="col-lg-4 col-md-6 col-xs-12">
                                <input placeholder="MIDDLE NAME" type="text" class="form-input" name="middleName" />
                                <p class="error" rel="middleName"></p>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-lg-8 col-md-6 col-xs-12">
                                <input placeholder="EMAIL ADDRESS" type="text" class="form-input" name="emailAddress" />
                                <p class="error" rel="emailAddress"></p>
                            </div>
                            <div class="col-lg-4 col-md-6 col-xs-12">
                                <input placeholder="MOBILE NUMBER" type="text" class="form-input" name="mobileNumber" />
                                <p class="error" rel="mobileNumber"></p>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-lg-12 col-md-6 col-xs-12">
                                <select placeholder="SELECT YOUR COURSE" class="form-input" name="course" >
                                    <option value="" disabled selected>SELECT YOUR COURSE</option>
                                    <option <?php echo ($course=="Software Engineering")?'selected':''; ?> value="Software Engineering">SOFTWARE ENGINEERING</option>
                                    <option <?php echo ($course=="Game Development")?'selected':''; ?> value="Game Development">GAME DEVELOPMENT</option>
                                    <option <?php echo ($course=="Web Development")?'selected':''; ?> value="Web Development">WEB DEVELOPMENT</option>
                                    <option <?php echo ($course=="Animation")?'selected':''; ?> value="Animation">GAME DEVELOPMENT</option>
                                    <option <?php echo ($course=="Multimedia Arts and Design")?'selected':''; ?> value="Multimedia Arts and Design">MULTIMEDIA ARTS & DESIGN</option>
                                    <option <?php echo ($course=="Fashion")?'selected':''; ?> value="Fashion">FASHION</option>
                                    <option <?php echo ($course=="Financial Management")?'selected':''; ?> value="Fashion">FINANCIAL MANAGEMENT</option>
                                    <option <?php echo ($course=="Marketing and Advertising")?'selected':''; ?> value="Marketing and Advertising">MARKETING AND ADVERTISING</option>
                                    
                                </select>
                                <p class="error" rel="course"></p>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-lg-8 col-md-6 col-xs-12">
                                <input placeholder="MAILING ADDRESS LINE 1" type="text" class="form-input" name="mailingAddress1" />
                                <p class="error" rel="mailingAddress1"></p>
                            </div>
                            <div class="col-lg-4 col-md-6 col-xs-12">
                                <input placeholder="CITY" type="text" class="form-input" name="city" />
                                <p class="error" rel="city"></p>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-lg-8 col-md-6 col-xs-12">
                                <input placeholder="MAILING ADDRESS LINE 2" type="text" class="form-input" name="mailingAddress2" />
                            </div>
                            <div class="col-lg-4 col-md-6 col-xs-12">
                                <input placeholder="PROVINCE" type="text" class="form-input" name="province" />
                                <p class="error" rel="province"></p>
                            </div>
                        </div>
                        <div class="row" style="width:20%;margin:3rem auto;">
                            <input type="submit" class="code-submit" value="SUBMIT" >
                        </div>
                        </form>
                    </div>
                </div>
            </div>
        </div>